Individual
MICHELE KAMP FAIRCLOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
7691 POPLAR AVE, GERMANTOWN, TN 38138-3904
(901) 516-1290
(901) 516-1220
Mailing address
1211 UNION AVE STE 330, MEMPHIS, TN 38104-6655
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
23748
MS
207R00000X
Internal Medicine Physician
Primary
48481
TN
208M00000X
Hospitalist Physician
23748
MS
208M00000X
Hospitalist Physician
48481
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03259503
—
MS
05
—
1529195
—
TN
05
—
193853001
—
AR
01
—
4330515
BCBS
TN
01
—
P01133352
RAILROAD MEDICARE
TN
Enumeration date
06/01/2009
Last updated
04/01/2024
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